Anatomy of the Duodenum, Pancreas and Spleen - PowerPoint PPT Presentation

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Anatomy of the Duodenum, Pancreas and Spleen

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Lymphatic drainage of the distal pancreas and spleen. Hepaticopancreatic ampulla (Ampulla of Vater) ... Zymogens: Trypsinogen Chymotrypsinogen, ... – PowerPoint PPT presentation

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Title: Anatomy of the Duodenum, Pancreas and Spleen


1
Chapter 19
PANCREAS
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OBJECTIVES
  • Understand the etiology/risk factors,
    pathogenesis, morphology, clinical features and
    outcome of pancreatic inflammations and neoplasms

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Chapter 19
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Posterior view of duodenum/pancreas
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Arterial supply and venous drainage of the
pancreas and spleen
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Lymphatic drainage of the distal pancreas and
spleen
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Hepaticopancreatic ampulla(Ampulla of Vater)
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Pancreatic Enzymes
  • Amylase
  • Lipase
  • DNA-ase
  • RNA-ase
  • Zymogens Trypsinogen Chymotrypsinogen,
    Procarboxypeptidase A, B

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PANCREAS DISEASES
  • Congenital
  • Inflammatory
  • Acute
  • Chronic
  • Cysts
  • Neoplasms

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Congenital
  • Agenesis (very rare)
  • Pancreas Divisum (failure of 2 ducts to fuse)
    (common)
  • Annular Pancreas (pancreas encircles duodenum)
    (rare)
  • Ectopic Pancreas (very common)

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PANCREATITIS
  • ACUTE (VERY SERIOUS)
  • CHRONIC

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CONSEQUENCES of ACUTE and CHRONIC pancreatitis
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ACUTE PANCREATITIS
  • ALCOHOLISM
  • Bile reflux
  • Medications (thiazides)
  • Hypertriglyceridemia, hypercalcemia
  • Acute ischemia
  • Trauma, blunt, iatrogenic
  • Genes PRSS1, SPINK1
  • Idiopathic, 10-20

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CLINICAL FEATURES
  • ABDOMINAL PAIN
  • EXTREME emergency situation
  • HIGH mortality
  • but MOST important lab test is.????? ?

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AMYLASE !!!!!!!
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MORPHOLOGY
  • EDEMA
  • FAT NECROSIS
  • ACUTE INFLAMMATORY INFILTRATE
  • PANCREAS AUTODIGESTION
  • BLOOD VESSEL DESTRUCTION

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CHRONIC PANCREATITIS
  • Pancreatic duct obstruction, LONGSTANDING
  • Tropical
  • Hereditary (PRSS1, SPINK1 mutations)
  • IDIOPATHIC (40)

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CHRONIC PANCREATITIS
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CLINICAL FEATURES
  • Abdominal Pain
  • Vague abdominal symptoms
  • Nothing
  • CT calcifications (why?), amylase elevated,
    chronic diarrhea if chronic pancreatic
    insuffiency develops, high likelihood of
    pseudocysts

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PDEUDOCYSTS
  • Why pseudo?
  • STRONGLY linked with pancreatitis
  • Can be as big as a football and often are.
  • Can cause obstruction
  • Can get infected
  • Do NOT become malignant

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Pancreas Neoplasms
  • Serous
  • Mucinous
  • Cystic
  • Microcystic
  • Papillary
  • Benign
  • Malignant (dense sclerosis is the rule)

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SEROUS CYSTADENOMA
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MUCINOUS CYSTADENOMA
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INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM
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CARCINOGENESISof PANCREATICADENOCARCINOMA
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Pancreatic CA
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Pancreatic Adenocarcinoma
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FATE
  • Regional lymph nodes
  • Liver
  • Often T-2 spine
  • Lungs
  • Grading (WMP), Staging, TNM

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Final TIP of the day
  • Painless jaundice in an elderly person is
    CARCINOMA of the head of the pancreas until
    proven otherwise
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